Symposia
S-01
Advances and challenges of evidence-based child and adolescent mental health:
Looking back, looking forward S-01-001
Advances in diagnosis and treatment of bipolar disorder in children and adolescents:
An international perspective R. Findling*
*Johns Hopkins Children´s Center, Baltimore, USA
Method: A selective overview of the most relevant and methodologically stringent papers will be provided. In addition, systematic-reviews and meta-analyses, when available, will be discussed.
Results: As for the diagnosis/phenomenology, there is a consensus that the accurate diagnosis of pediatric BPD can be made with implementation of unmodified DSM criteria. However, global consensus regarding the diagnosis of cyclothymia and other specified bipolar disorder (BPD Not Otherwise Specified) is still needed. In terms of treatment, meta-analytic evidence shows greater acute efficacy in the treatment of mania for several second-generation antipsychotics (SGAs) when compared with anticonvulsants and lithium. Additionally, it should be noted that psychosocial interventions are also recommended as adjunctive treatments for BPD in youth. There is also growing body of evidence regarding the pharmacotherapy of the depressed phase of bipolar illness as well as maintenance medication treatment of pediatric BPD.
Conclusion: Despite significant progress in the field of pediatric BPD over the past few years, more research is needed on the phenomenology, pathophysiology, course and treatment of this condition in youth.
Background: Over the past two decades, bipolar disorder in children/adolescent has been one of the most controversial topics in child and adolescent psychiatry. In this presentation, these
S. Cortese*
*Winchester, United Kingdom
Method: Given the large body of literature and space constraints, the review will be selective rather than systematic and comprehensive. I will rely mostly on meta-analyses, retrieved with a search in PubMed using the following syntax/terms (update: 8 August 2018): (ADHD OR Attention Deficit OR Hyperkinetic Disorder) AND (meta-analy* OR metaanaly).
Results: I will highlight:(1) the most recent changes to the diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders and International Classification of Diseases; (2) meta- analytic evidence showing that, after accounting for diagnostic methods, the rates of ADHD are fairly consistent across Western countries; (3) the recent finding of the first genome-wide significant risk loci for ADHD; (4) the paradigm shift in the pathophysiological conceptualisation of ADHD from alterations in individual brain regions to a complex dysfunction in brain networks; (5) evidence supporting the short term efficacy of ADHD pharmacological treatments, with a different profile of efficacy and tolerability in children/adolescents versus adults; (6) a series of meta-analyses showing that, while non-pharmacological treatment may not be effective to target ADHD core symptoms, some of them effectively address ADHD-related impairments (such as oppositional behaviours for parent training and working memory deficits for cognitive training).
Conclusion: Overall, while many research questions have been answered, many others need to be addressed. Strengthening multidisciplinary collaborations, relying on large data sets in the spirit of Open Science and supporting research in less advantaged countries will be key to face the challenges ahead.
Background: I will summarise what in our view have been some the most important advances in the past two decades, in terms of diagnostic definition, epidemiology, genetics and environmental causes, neuroimaging/cognition and treatment of attention-deficit/hyperactivity disorder (ADHD)
S-01-003
Twenty years of progress in pediatric psychopharmacology: Accomplishments and unmet needs
B. Vitiello*, C. Davico
*University of Turin, Italy
Objective: Pediatric psychopharmacology as a specific section of psychopharmacology is relatively recent. It was only in the late 1990s that the need for a systematic evaluation of the efficacy and safety of psychotropic medications in children emerged in the scientific community. Here, we reviewed the past two decades of research on pediatric psychopharmacology in children and adolescents and highlight future direction in the field.
Method: Randomised clinical trials that tested the treatment effects of psychotropic medication in children were searched in Pubmed. The search terms included: children and stimulants or antidepressants or antipsychotics or mood stabilizers or lithium, and meta-analysis or systematic review.
Results: A significant increase in the number and sized of controlled clinical trials occurred in the last twenty years. Available studies have been informative of the pediatric pharmacokinetics, efficacy and safety of the most commonly used psychotropics. Clinical guidelines have bene published, informed in part by meta-analytic evidence. However, most clinical trials have been conducted in research settings, and this limits the generalizability of the results.
Conclusion: Although available evidence on pediatric psychopharmacology is informative on the efficacy and tolerability at the group level, additonal pragmatic trials and analyses of large population trials are needed to inform daily clinical practice. Focusing on the neurobiological mechanisms of child psychopathology may lead to the identification of more precise pharmacological targets, within a developmental perspective.
S-02-001
Precision and prediction of outcomes following treatment for depressed adolescents I. Goodyer*
*Cambridge University, Psychiatry, United Kingdom
Objective: To determine if specialist psychological treatments are more clinically effective in reducing depressive symptoms than a brief psychosocial intervention 12 months after the end of treatment in adolescents with major depression.
Method: Randomised controlled treatment trial of 465 major depression in adolescents attending adolescent mental health services.
Results: clinical effectiveness was equivalent between 3 psychological treatments of brief psychosocial intervention , cognitive behaviour therapy and short term psychoanalytic therapy.
There were no predictors of treatment response or non response.
Conclusion: Better methods for revealing treatment response and non response need to be developed to aid clinical decision making. This requires a better method for determining the course of disorder following treatment and then examining for predictors, moderators and mediators on the revealed trajectories.
S-02-002
Brief psychosocial intervention for depressed adolescents (BPI) R. Kelvin*
*Cambridge University, Royal College of Psychaitrists, London, United Kingdom
Objective: To describe and discuss the Characteristics of BPI. What is BPI and how can it help services? BPI is a synthesis of the components of good quality, personalised, collaborative routine care. It is a coherent, audit-able, manualised, structured clinical intervention. Such a formal structuring of good quality care has been lacking to date. In the IMPACT RCT it was refined to represent the reference good quality usual care condition.
Method: The RCT was a pragmatic superiority randomised controlled trial of 465 adolescents with major depression randomised to one of 3 psychological treatments: brief psychosocial intervention (BPI); cognitive behaviour therapy (CBT); short term psychanalytic therapy (STPP). Patients were followed for one year post treatment.
Results: All three treatments were clinically and cost effectively equivalent end of treatment and end points of the study, at 36, 52 and 86 weeks.
Conclusion: BPI is a new and effective treatment to add to existing therapies for the treatment of major depression in adolescents. We suggest that BPI supports service quality improvement and safety assurance. It may also have applications beyond specialised depression care.
P. Wilkinson*
*Cambridge University, Psychiatry, Douglas House, United Kingdom
Objective: Self-harm can be conceptualized as being suicidal or non-suicidal. In the ADAPT study, the strongest multivariate predictor of non-suicidal self-injury (NSSI) over 28 weeks was baseline NSSI.
The main multivariate predictors of suicide attempts were baseline NSSI and poor family function.
These findings were replicated in the TORDIA study. Both ADAPT and TORDIA found non-significant trends for high depression severity to predict self-harm. We aimed to investigate whether baseline self-harm and depression severity predicted self-harm in a larger sample of depressed adolescents.
Method: We tested for baseline predictors of suicidal and non-suicidal self-harm in 465 depressed adolescents over 86 weeks follow-up in the IMPACT study, using Cox regression and multiple imputation for missing data. The larger sample size and longer follow-up gave us greater statistical power than the ADAPT and TORDIA analyses.
Results: The main multivariate predictors for NSSI were baseline NSSI and high severity of depressive symptoms. The main multivariate predictor for suicide attempts was high severity of depressive symptoms.
Conclusion: Larger sample size and follow-up period are likely to make results more robust than for ADAPT. High severity of depression does predict both types of self-harm, indicating this is an important risk marker. NSSI is a strong predictor of future NSSI. However neither type of self-harm predicted suicide attempts, which was a surprising finding; that may reflect the fact that baseline measurement was lifetime, and it may be more proximal self-harm only which predicts suicide attempts.
S-02-004
The IMPACT Pragmatic Randomised Controlled Trial of major depression in adolescents: Implications for policy and practise
B. Dubicka*
*Royal College of Psychiatrists, Chair of CAP Faculty, London, United Kingdom
Objective: There is a very large therapeutic and policy challenge ahead for adolescent mental health in the UK, as well as in other parts of the world. The potential value of a Brief Psychosocial Intervention (BPI) that may be deliverable in the community and in clinics by community and non specialist staff will be outlined and discussed.
Method: Data from UK recent sources will be presented regarding the recent surge in demand for adolescent mental health services. A 2018 UK epidemiological survey has confirmed an overall increase in prevalence of mental health disorders, and particularly high rates were found for older adolescent girls with emotional disorders. This demand for services has been accompanied by a shortfall in recruitment for psychiatrists as demonstrated by data from the Royal College of Psychiatrists (RCPsych), and other child and adolescent mental health professionals. Within this context, our earlier ADAPT trial reported that a BPI was as effective as a more specialised therapy when added to an antidepressant and this led to the development of the IMPACT BPI manual for adolescent depression.
Results: The IMPACT trial found that BPI was as clinically and cost effective as more specialised therapies and therefore has the potential to help meet the demand for first-line services. A number of government initiatives will be briefly described such as the Increasing Access to Psychological Treatment program, mental health teams for schools, and also a focus on early intervention and prevention through integrated systems (e.g. the i-Thrive model) and youth services. Various workforce initiatives have also been undertaken to meet the workforce challenge.
Conclusion: The size of the challenge requires that first-line cost-effective brief interventions such as BPI are readily available that can be delivered by non-specialist staff, reserving scarcer, more
challenges
Chairpersons: J. Schwarzenberg, Austria; D. Koubek, Austria J. Schwarzenberg*
*Medical University of Vienna, Austria
S-03-001
PTSD and Conduct Disorder (CD) from a clinical perspective D. Koubek*
*Praxis Dr. Doris Koubek, Linz, Austria
Objective: Children and adolescents who have experienced trauma are at high risk of developing PTSD. In clinical care, this group of patients are often presented first with CD associated with severe depressive and dysphoric symptoms. It has been proven that the challenge in outpatient care is to give the right diagnosis and further to establish the appropriate treatment for this specific group of patients suffering from PTSD. This presentation will give an insight into the complex work with outpatients and their families.
Method: The current study applies an epidemiological design in a sample of 392 adolescents in outpatient care.
Results: Seventyfive percent of patients suffering from CD also displayed symptoms of traumatization or fulfilled criteria for PTSD. Diagnosing PTSD in the present sample required an extensive clinical assessment which will be described in detail.
Conclusion: Implications for clinical care are discussed and recommendations for diagnosing this vulnerable patient sample are exemplified.
S-03-002
Psychiatric profile of adolescents and young adults in prisons: Emphasis on traumatic events and substance use
M. Silbernagl*, G. Fischer
*Medical University of Vienna, Austria
Objective: Adolescents and young adults in prisons suffer from a high risk of psychiatric disorders.
In addition to the current imprisonment, many experienced traumatic events in the past and frequently engaged into substance use. Research in prisoners and in minors is restricted due to ethical reasons, resulting in a lack of valid data for this particular group, which would facilitate the implementation of therapy and treatment standards.
Method: Screening of Axis I psychiatric comorbidities, antisocial personality disorder and ADHD using standardized psychiatric interviews and questionnaires in adolescent (14 –17 years) and young adult (18 –26 years) inmates (Mini International Neuropsychiatric Interview, Adult ADHD self-report scale, Wender Utah Rating Scale). Forensic history and substance use was investigated using the European Addiction Severity Index including crime module and full records of prescribed medication were retrieved from inmates’ files.
Results: Participants were 71 adolescents/young adults in custody (all male; age range 14.9 –26.7 years; mean age 19.8 years) with a mean of 25.0 months spent in custody lifetime. Psychiatric comorbidities were highly prevalent and 25.4% of inmates suffered from current suicide risk. Abuse by a relative was experienced by 11.6% (mainly emotional and physical) and 50% experienced a traumatic event at some point in their life. Full criteria for current (last month) PTSD were met by 1.5%. For prescribed pharmacological medication, 32.5% received antipsychotics, 25.4%
antidepressant and 19.7% benzodiazepines. The majority of participants reported lifetime abuse of cannabis (76.1%), followed by cocaine (39.4%) and amphetamines (28.2%), with 35.2% reported any drug use in the last 30 days.
Conclusion: Imprisoned adolescents and young adults are a highly vulnerable group with a history
J. Blair*
*Boys Town, USA
Objective: Maltreatment generally and abuse in particular are linked to an increased risk for reactive aggression. Reactive aggression has been related to increased responsiveness of basic threat circuitry (amygdala-hypothalamus-periaqueductal gray), decreased frontal regulatory activity within ventromedial frontal cortex and potentially faciliatory activity within neural systems engaged in response control (dorsomedial and dorsolateral frontal and anterior insula cortices). However, previous work has not examined the extent to which maltreatment has an impact on these neural systems when they are engaged in retaliation/reactive aggression.
Method: 200 participants were recruited from the community and shortly after their arrival at a residential care facility to which they had been referred for severe behavioral and mental health problems. Participants were scanned while they performed a retaliation paradigm variant of the Ultimatum game. Participants were offered shares of money by “partners” that could be either fair (50:50 split) or various levels of unfair. Participants could choose to accept these offers or retaliate (spend their own money to take money from their partners.
Results: Increasing levels of abuse had an impact on several of the systems mediating reactive aggression/retaliation. These results will be discussed in terms of: (i) understanding why maltreatment increases the risk for aggression; and (ii) treatment targets for interventions designed to ameliorate the impact of maltreatment.
S-03-004
Defense mechanism is predicted by attachment and mediates the maladaptive influence of insecure attachment on adolescent mental health
C. Laczkovics*, G. Fonzo, B. Bendixsen, E. Shpigel, I. Lee, K. Skala, A. Prunas, J. Gross, H.
Steiner, J. Schwarzenberg
*Medical University Vienna, Child / adolescent psychiatry, Wien, Austria
There is limited research exploring attachment style and defenses in adolescents. The purpose of the current research is to explore the relationship between adolescent attachment style and development of defense mechanisms, as well as attachment style and problem behaviors. A total of 1487 students from two California high-schools completed three self-report questionnaires to establish defense mechanisms, psychiatric symptoms, and attachment style. Attachment styles characterized by a positive self-image predict greater levels of mature defense mechanisms, and lower levels of immature defense mechanisms, both in the interpersonal and intrapsychic domains.
Relationships between insecure attachment styles and psychopathology were mediated by greater levels of immature defense mechanisms. Disorganized attachment and trauma will be discussed in the light of defense mechanisms. The way in which one relates to others early in life may affect how one then self-regulates using defense mechanisms. These results provide initial compelling evidence that: a) attachment style is an important determinant of the type of defense mechanisms utilized by the individual to maintain psychological stability; and b) defense mechanisms serve to transmit the detrimental effects of insecure attachment style on psychological health.
J. Schwarzenberg*, A. Etkin
*Medical University of Vienna, Austria
Objective: To investigate whether leveraging individual differences in core information processing impairments associated with PTSD patients could reveal biophenotypes within the disorder that are clinically- and mechanistically-relevant.
Method: The current study applies a multimodal study design, encompassing concurrent focal non-invasive transcranial magnetic stimulation (TMS) and electroencephalography, neuropsychology, brain imaging, amongst others.
Results: We found that a subgroup of PTSD patients from two independent cohorts displayed both aberrant functional connectivity within the ventral attention network (VAN) and impaired verbal memory. This combined phenotype predicted resistance to psychotherapy, the best-validated treatment for PTSD. We then identified alterations in neural signal flow in the VAN evoked by direct stimulation of that network that were associated with these individual differences in within-VAN functional connectivity.
Conclusion: Our findings leverage objective neurobiological mechanisms to define an otherwise- latent but prognostically-relevant phenotype within the broader clinical syndrome of PTSD.
S-04
Internet and digital media in child and adolescent psychiatry:
From problem to therapy
Chairpersons: M. Fuchs, Austria; O. Bilke-Hentsch, Switzerland M. Fuchs*
*Medical University Innsbruck, Child and Adolescent, Psychiatry, Hall In Tirol, Austria
S-04-001
Pathological internet use as an important comorbidity in child and adolescent
psychiatry: Prevalence and correlation patterns in a naturalistic sample of adolescent inpatients
M. Fuchs*
*Medical University Innsbruck, Child and Adolescent, Psychiatry, Hall In Tirol, Austria
Method: 111 child and adolescent psychiatry inpatients (CAP-IP, mean age years; female : male 72.4% : 27.6%) undergoing routine psychodiagnostics were screened for the presence of PIU.
The widely used Compulsive Internet Use Scale (CIUS) was chosen for this purpose. Prevalence rates of PIU were then compared to matched nonreferred control subjects from a school sample.
Additionally, comorbidities of inpatients with PIU were compared to inpatients without PIU.
Results: Our inpatient sample showed a much higher prevalence of PIU than that found in previous populational samples of young people. Compared with a matched school sample, addictive internet use was 7.8 times higher and problematic internet use 3.3 times higher among our adolescent sample. PIU was significantly associated with characteristic patterns of psychopathology, that is, suicidality, difficulties in establishing stable and consolidated identity, and peer victimization.
Conclusion: PIU among adolescents undergoing inpatient psychiatric treatment is much more frequent than among their peers in the general population and is associated with specific patterns of psychopathology.
K. Winds*, C. Skrivanek, L. Thun-Hohenstein, B. Plattner
*Univ. Klinik f. Kinder-, und Jugendpsychiatrie, PMU Salzburg, Austria
Objective: To investigate internet behavior in hospitalized juveniles and to outline possible links between personality traits, psychopathology and patterns of internet use and misuse.
Method: A cohort of juveniles admitted to an Austrian university impatient clinic was tested for their internet behavior with AICA-S (Scale for the Assessment of Internet and Computer Game Addiction) and CIUS (Compulsive Internet Use Scale). Psychopathology was assessed using the Mini Kid (Mini International Neuropsychiatric Interview for children and adolescents) and the YSR (Youth Self Report). For the assessment of personality the JTCI (Junior Temperament and Character Inventory) was used.
Results: Preliminary data of a sample of 30 showed that a majority of the sample was female (73.3%). Psychopathology was highly prevalent. The most common diagnoses were lifetime major depressive disorder (70%), dysthymia (70%) and panic disorder (70%). Mean internet behavior variables ranged from 0.57 ± 1.073 to 2.77 ± 1.695 in the AICA and 1.70 ± 0.915 and 3.43 ± 1.165 in the CIUS.
Conclusion: Problematic internet behavior might be another expression of severe psychopathology or serves as a compensatory mechanism when other levels of functioning are severely affected.
Preliminary results point in that direction. Further analyses are needed.
S-04-003
Online peer victimization: Results from a school and clinical survey N. Haid-Stecher*, K. Sevecke
*Tirol Kliniken, Abteilung f. Kinder-, und Jugendpsychiatrie, Hall I. Tirol, Austria
Objective: The aim of the study is to demonstrate the prevalence of online peer victimisation in healthy children and adolescents (n=800) in comparision to psychiatric inpatients at the child and adolescent psychiatry. Furthermore we investigate relations between online peer victimisation, sociodemographic and psychopathological variables.
Method: The survey was conducted at five schools and at the child and adolescent psychiatry in the Tyrol. A total number of 800 pupils, and at that time, 40 inpatients comleted the study. Online Peer victimisation was measured with the German version of the Multidimensional offline and online peer victimisation scale, psychopathological variables with the Strenght and difficulties questionaire.
Results: Our preliminary results show a high prevalence of peer victimisation in children and adolescent. Although cases of indirect online peer victimisation are least frequent, victims are most severly affected by decreased well-being.
Conclusion: A significant number of adolescent in our sample experienced peer victimistion and associated psychological strains. This should especially be considered in child and adolescent anamnesis.
Technology- and media based interventions in severe cases of adolescent IGD and MUD
O. Bilke-Hentsch*
*Modellstation SOMOSA, Winterthur, Switzerland
Method: Brand et al. (2016) recently proposed a model of pathological media and internet use, which will be very useful top plan interventions. A working group consisting of neuropsychologists, clinical psychologists, pedagogic experts, a professional game–tester, and developmental psychiatrists developed the SOMOSA MediaLabR concept. It includes in-depth neuropsychological testing, cognitive remediation, a real-life office simulation setting, a set of individually tailored computer games, creative software programs, a high-end music recording and producing facility, and the possibility to optimize and critically reflect the social media behavior of the patients.
Results: The first phase of the implementation of the SOMOSA MediaLabR program integrated patients with ASS, PTSD, and hyper-impulsivity due to ADHD or dissocial developments. The modular concept and the individualized set of methods of DITs provided a well-accepted and personalized approach. The adolescents were in very close cooperation with the professional team to ameliorate the concept. Motivational aspects played a key role in adherence to the tight schedule and multiple demands of the MediaLab-programme.
Conclusion: As adolescents with severe and comorbid mental disorders show specific problems in age- and content- adequate usage of electronic media, we advocate an intensified integration of DITs in inpatient therapeutic institutions for children and adolescents. The SOMOSA MediaLabR concept might constitute a promising first step towards the integration of DITs in multisystemic therapy in this age group.
Background: Since 1995the impact of digital interactive technologies (DITs) on personal and professional life has increased exponentially. In the near future, body-attached devices will constantly provide the user with data of the world around and within him. Innovative DITs seem to offer endless possibilities. However, they also influence the manifestation and course of mental illnesses and cause specific disorders.
S-04-005
Virtual reality interventions in child and adolescent psychiatry: Recent developments and future challenges
O. Kothgassner*
*Medical University of Vienna, Child & Adolescent Psychiatry, Viena, Austria
Method: Research regarding the importance of presence as important factor for VR treatment and problems of health professionals with VR health technology will be discussed. Furthermore, two game-based VR treatments for children and adolescents will be presented: (1) the concept and first results of a VR-based cognitive training for children and adolescents with ADHD as well as (2) the concept and first experiences concerning a VR-biofeedback for adolescents with stress- related disorders.
Results: Alongside the positive effects of VR, game-based VR-therapy in children and adolescents with ADHD show a significant reduction of symptom severity. But, there are still barriers (e.g.
acceptance, usability, costs) to include VR therapy in clinical practice.
Conclusion: Indeed, research indicates VR will be an important approach in treating mental disorders of children and adolescents, but nevertheless there are still many challenges using VR in therapy regarding usability, developmental costs, as well as a rapidly growing field of Information and Communication technology.
Background: The last two decades showed a rapid increase of research regarding Virtual Reality (VR) in the assessment and treatment of mental health disorders. There is plenty of research providing evidence of VR as effective enhancement of traditional therapy (e.g. exposure therapy, pain therapy).
VR provides authentic settings, with a higher degree of control. Moreover, newer developments allow including game-based narratives and moving VR treatments forward to a more complex and holistic method in therapy.
Chairpersons: A. Belger, USA; C. Piguet, Switzerland A. Belger*
*University of North Carolina, Psychiatry, Chapel Hill, USA
S-05-001
Gaze and working memory processing in offspring of bipolar and borderline parents revealed by electrical neuroimaging
C. Berchio*, A.-L. Kung, E. Pham, A. Dayer, J.-M. Aubry, C. Michel, N. Perroud, C. Piguet
*University of Geneva, Department of Psychiatry, Switzerland
Method: In order to look at the different chronological steps of face processing, we used high density EEG, and a validated a delayed face matching task, where faces with direct and averted gaze were presented (Berchio et al., 2016). This paradigm has been used to collect data in three high-risk groups: offspring of bipolar (BD) (age range: 15-25), borderline personality disorder (BPD) (age range: 15-25), and ADHD (age range: 15-25) parents.
Results: To disambiguate between genetic risk factors, we compared BD, BPD, and ADHD offspring.
The P200 component, which is implicated in eye-gaze cues decoding, differentiated high-risk groups from age-matched controls. Preliminary data indicated that risk for BD is associated with enhanced visual responses to faces, and overall risk for emotional dysregulation to P200 abnormalities.
Interestingly, ADHD offspring showed reduced P200 amplitudes in response to averted gaze.
Electrical neuro-imaging offered some insights into how the social brain’s development is altered in at high-risk offspring relative to individuals who have no family history of emotional-related disorders.
Conclusion: This study sheds new light on the neurobiology of social cognition in affective disorders, and suggests the P200 component as a physiological vulnerability marker of emotional dysregulation.
Background: Despite increasing interest in how abnormalities of the social brain lead to the emergence of emotional dysregulation disorders, current studies have been limited in several aspects.
Here, we seek to delineate brain network abnormalities in eye-gaze processing of youth who have
S-05-002
Children at risk for eating disorders: Understanding endophenotypes, a pilot study N. Micali*
*SPEA direction, Geneva, Switzerland
Method: We assessed a total of 17 girls between the ages of 8 and 15 whose mothers had and ED at some point in their life, and 29 age-matched girls of mothers who had never had a psychiatric illness. Girls performed a battery of neuropsychological tests from the CANTAB battery and underwent a brain MRI.
Results: Children at high risk for ED performed signifincaly worse on a spatial working memory and attention task compared to controls. Differences in Grey matter volumes were also identified across groups. Increased GM volume in the amygdala and caudate in children at high-risk for ED were identified compared to children of HC mothers.
Conclusion: Although preliminary, these findings have allowed us to start understanding possible brain and neuropsychologial characteristics that might predispose young people to developing an ED. We are extending this pilot work in a larger study.
Background: Eating Disorders (ED) have the highest mortality rates of any other psychiatric disorder, however, unlike in other disorders, there has not been much research into specific vulnerabilities for their development. In the last decades, there have been advances in our understanding of the neuropsychological and brain characteristics present in ED. First-degree relatives have a higher risk of developing the disorder and might present similar neuropsychological and brain characteristics (possibly endophenotypes) as sufferers. One way of understanding these endophenotypes is to study children of parents with ED who do not have symptoms.
C. Piguet*
*University of Geneva, Psychiatry, Geneve, Switzerland
Method: Twenty-two remitted patients, 18 healthy offspring and their respective matched healthy controls underwent an adapted version of the MIST task while brain activity was registered in a functional MRI. The task consisted of mental calculations in a given time frame followed by a positive or negative social feedback and resting periods of 90sec in order to address recovery from stress.
A PPI approach was used to explore connectivity patterns of frontal gyrus, cingulate cortex and amygdala across conditions.
Results: In healthy offspring, a pattern similar to the one encountered in patients was observed, with amygdala being more active after a negative (vs positive) feedback as compared to healthy controls and such activity strongly correlated with dmPFC during social feedback. However, during recovery from negative feedback and concomitantly with amygdala hyperactivity, offspring showed also higher middle cingulate activity. This activity was strongly connected with other regulatory areas such as anterior and posterior cingulate, and was found to correlate with adaptive regulation strategies in healthy bipolar offspring.
Conclusion: Altogether these results suggest heightened limbic sensitivity in response to a social stressor in both bipolar patients and healthy bipolar offspring. While in patients such activity was linked to dmPFC and anxiety levels, in offspring, parallel activity in cingulate cortices was related to adaptive regulation strategies, suggesting both vulnerability and resilience signs in healthy high- risk populations.
Background: Emotional dysregulation is a core feature of many psychiatric disorders, including bipolar disorder, and a prominent risk factor for mood disorders in bipolar offspring. We here investigated the dynamics of the cortico-limbic network underlying emotion regulation during and after a social stressor in both remitted bipolar patients and healthy bipolar offspring, in order to determine components of this network that underlie vulnerability or resilience in high risk populations.
S-05-004
Multimodal imaging of stress effects on working memory capacity in adolescents at risk
A. Belger*
*University of North Carolina, Psychiatry, Chapel Hill, USA
Method: Sixty-five participants (aged 9-16) underwent functional imaging and EEG recordings during a working memory task (0-, 1-, and 2-back) before and after psychosocial stress test. FMRI data was analyzed using FSL. EEG data was recorded using Biosemi Active 2 64 channel and analyzed using EEGLAB and custom Matlab scripts
Results: Neuroimaging results revealed (1) A significant (p<.01 corrected) reduction in prefrontal activation during working memory following stress exposure, coupled with a significant (p<.01) increase in posterior occipital activation. (2) Reduced prefrontal activation in the 2-back relative to 1-back condition following stress. (3) Children at high-risk for psychosis (ADHD/ANXIETY/or familial-high risk) showed increased sensitivity to this stress effect (p<.01). EEG results indicated that (1) stress interacts with WM load and influences differ in those at HR: Neural oscillatory signals at Θ activity, bands were disrupted by stress (p <.01), (2) Increases frontal Ɵ post-stress in 2-back WM load, decreased frontal Ɵ post-stress in 1-back.; controls showed increased activity in ϴ and α with increased load, while HR showed decreased theta activity with increased load. Combined FIT analyses indicated that when controlling for the impact of cognitive disorganization, anxiety was significantly related to the neural circuitry stress-related changes (β = -0.30, p = 0.04).
Conclusion: Stress exacerbated imaging and EEG measures of WM, highlighting its influential role in at-risk group and in this age window. Thus, aberrant stress response and recovery may procure unique vulnerabilities for the development of psychotic disorders in adolescents.
Background: Psychosocial stress is a key trigger for neuropsychiatric disorders in adolescence.
Prefrontal neural networks that regulate the stress response are unique targets for stress-induced modulation of adolescent brain and cognition. We examined the impact of acute stress on neural
schizophrenia and bipolar disorder K. J. von Plessen*
*University of Lausanne, Psychiatry, Switzerland
Method: In this presentation we will start out by presenting the literature examining young (<23 years) first-degree relatives (FDR) of individuals with schizophrenia and individuals with bipolar disorder with respect to motor and cognitive development, using EEG and functional MRI. The existing studies can be classified with respect to their tasks during the functional MRI, spanning from simple tasks requiring cognitive control, working memory, verbal decision task to tasks requiring higher order functions, such as emotional perception, motivation and social cognition.
Results: First, we will review the existing literature, while focusing on tasks involving cognitive control and self-regulation in those young individuals at risk by discussing the overall findings for these studies that largely identify consistent findings between individuals with the manifest disorder and individuals at risk. Secondly, we will make the point to include measures of cognitive control to map activation during self-regulation, more specific the process of error-monitoring and subsequent behavioural adaptation in this population. Furthermore, the use of Diffusion Tensor Imaging (DTI), as well as functional MRI at resting state and EEG will allow for studying connectivity in the brain across multiple modalities.
Conclusion: Neurobiological outcomes may be analysed together with protective and with risk factors, such as environmental exposures through pregnancy, perinatal period and childhood, familial risk status and severity of parental mental disorders, as well as polygenic risk scores for schizophrenia and bipolar disorder.
Background: The overall objective of the presentation is to discuss approaches to study underlying neurobiology within the concept of endophenotypes in young individuals at high genetic risk for developing severe mental disorders. Using a strategy of “enriched recruitment” in several large studies will further shed light on the specific behavioural and neurobiological profile, focusing on the tight interrelatedness of motor-and cognitive development within a context of self-regulation and resilience.
S-06
Technology for youth mental health: Involving users, oportunities and ethical implications
Chairpersons: T. Akkaya-Kalayci, Austria; G. Fitzpatrick, Austria T. Akkaya-Kalayci*
*Medical University of Vienna, Child and Adolescent, Psychiatry, Austria
S-06-001
A Survey of Online Help-seeking in Young People C. Pretorius*
*University College Dublin, School of Information and, Communication Studies, Ireland
Method: This study made use of an anonymous online survey. Young people aged 18 –25 (N=
1308) living in Ireland participated in the online survey and were recruited through the use of social media ads on Twitter and Facebook.
Results: The largely undergraduate sample (60.5%) identified a number of concerns for which they had sought help and information for online. Areas that caused great personal or emotional concern include school or college, exams and body image. Young people were also using the internet to help to find help for these concerns. Young people indicated that they were most likely to use their mobile phones to look for help and information online for personal and emotional concerns. Many had looked online for more information about their own concerns, however many of them had also used the internet to look for help for a family member or friend. Young people deemed online resources to be credible if they were endorsed by the health service and/or their college.
Conclusion: The present research suggests that there is a need for online resources to cater for mobile users; providing information that is age-appropriate and relevant to the challenges young people face in their current life stage. Online resources need to consider how they can better facilitate the help-seeking of young people on behalf of their loved ones.
using technology-assisted mental health interventions D. McCashin*
*University College Dublin, School of Information and, Communication Studies, Ireland
Method: This study applied systematic reviewing method of qualitative synthesis – devised by Thomas & Harden (2008).
Results: Overall, 14 diverse studies were included. There were 5 key emerging themes: the helpfulness of cCBT for children, the therapeutic process within cCBT for children, the transferability of cCBT, the cCBT gameplay experience, and the limitations of cCBT for children. Significantly, children reported that cCBT was helpful for their mental or physical difficulties and the supporting quotation was illustrative of notable therapeutic and gameplay experiences.
Conclusion: These findings underscore the utility of cCBT interventions for a range of mental and physical difficulties for children. Importantly, all data were directly from the experiences reported by children. Additionally, there were interesting considerations indicated by children with respect to the gameplay experience and transferability of cCBT that can help this multidisciplinary field consider future iterations of cCBT. (Note: At the time of writing, this research is being prepared for submission to the Journal of Medical Internet Research (JMIR)).
Background: Qualitative methodologies are an integral part of digital child mental health research, where service user perspectives are increasingly influencing both research and policy. The ‘voice’
of the child user is required when designing, implementing, and evaluating digital interventions.
Accordingly, this study describes the use of qualitative synthesis to describe the experiences of children using computerised cognitive behavioural therapy (cCBT) for any mental or physical issue.
S-06-003
Digital support for young people who engage in self-harm: The users’ perspective A. Cus*
*Medical University of Vienna, Department of Child and, Adolescent Psychiatry, Austria
Method: This on-going qualitative study employs semi-structured interviews with patients presenting to mental health services due to self-harm. Eligible are patients aged 12-18 years who reported more than five episodes of self-harm in the past year. The data is analysed using the thematic analysis approach.
Results: Nine interviews have been conducted thus far. Preliminary results show that some young people have had experiences with seeking help online and found it partially helpful. This study shows that the available tools could be improved by considering the individuality of patients’ needs and expectations. Further, while many patients expressed interest in using mobile applications to manage self-harm, the most common motivation to use online support is the perception of digital resources as being effective and experiencing mood improvements after using them.
Conclusion: The study shows that future intervention developments should include target users‘
perspective in the development of mental health interventions to better respond to their needs and preferences, and to ensure user engagement with developed interventions.
Background: Self-harm is an important adolescent mental health problem. Lately, there has been an increase in promising online mental health interventions; however, few studies have included the perspectives of people intending to use them. On the other hand, patient participation has been recognized as an important factor for increasing engagement with digital tools. Therefore, further research about patients’ perspectives is a crucial gap that needs attention. Accordingly, this study aims to identify (1) whether young people use technology-enabled support to reduce their self- harming behaviour and (2) what technology-enabled solutions they wish to have available when they feel the urge to self-harm.
– outcomes of a feasibility trial
B. Moltrecht*, P. Patalay, J. Edrooke-Childs, J. Deighton
*Anna Freud National Centre for, Children and Families, EBPU, London, United Kingdom
Objective: Most mental health disorders, including depression, substance abuse, eating disorders and anxiety have their onset during adolescence. It has been argued that this peak in psychopathological symptoms is a result of developmental changes, which hamper emotion regulation (ER). The transition from late childhood to early adolescence is a critical period to target ER and prevent the development of more severe mental disorders. The present study evaluates the feasibility and effectiveness of a digital, classroom-based ER intervention developed for and by young people.
Method: Intervention components derived from co-design workshops and various evidence-based methods from existing therapies, including cognitive-behavioural therapy and dialectic-behavioural therapy. In total 4 primary schools in the London area participate in the trial (n=320). All children between the ages of 10-12 are eligible to take part. The intervention, is used for 3 months on tablets located in the classroom. Outcomes are measured via self-report questionnaires and short interviews.
Results: Children could identify with the content of the psychoeducational animations and found the exercises on the app engaging. Further insights regarding the development of digital interventions are presented, as well as outcomes from the trial regarding user acceptability barriers and facilitators of digital interventions in the classroom setting (child and teacher perspectives).
Conclusion: This study provides important information about the feasibility and effectiveness of a digital mental health intervention for young people and informs a future RCT.
S-06-005
Using computer games to support adolescent mental health interventions: Lessons from a deployment study
D. McCashin*, H. van der Meulen
*University College Dublin, School of Information and, Communication Studies, Ireland
Method: Pesky gNATs has been made available to therapists through a not-for-profit organisation.
After one year, we collected data from therapists who have used the game, using an online survey and follow-up semi-structured interviews. The data collection addressed the expectations and experiences of both therapists and young people and also sought opinions on key themes including the flexibility of the technology and attitudes towards user-generated versus automated adaptations in future versions. We used thematic analysis to identify key themes in the data.
Results: 21 therapists completed the online survey and five therapists participated in the follow-up interview. Confirming previous assessments, data suggests that the game can be helpful in delivering therapy and that the young people generally liked the approach. However, therapists shared diverse opinions regarding the young people for whom they deem the game appropriate. Three themes were identified: 1) stages of use; 2) impact on the delivery of therapy; 3) further developments.
We discuss therapists’ reflections on the game regarding their work practices and consider the question of customisation, including the delicate balance of adaptable interaction versus the need for fidelity to a therapeutic model.
Conclusion: This research provides further evidence that therapeutic games can be helpful in the delivery of therapy. However, therapists’ autonomy and decisions on when, with who and how to use technology varies strongly. This needs to be considered when designing technologies. This work has been submitted to JMIR Mental Health
Background: Research has highlighted the natural uptake as a barrier that limits the impact of technology that supports mental health interventions. Despite increasing evidence regarding the efficacy of computerised interventions, there is also increasing evidence that technologies are not
youth F. Tachtler*
*TU Wien, Institute of Visual Computing, and Human-Centered Technology, Vienna, Austria
Method: We interviewed experts, young people and informal caregivers and combined the results of our thematic analysis with the findings of a review of current evidence-based approaches for promoting resilience in unaccompanied migrant youth.
Results: The results indicated the importance of the relationship between the young person and informal caregivers, and the need of supporting these informal caregivers (who are non-mental health professionals) to help them promote resilience skills in their mentee. We identified mental health interventions that were offered by experts, but also by the informal caregivers.
Conclusion: Technology could assist informal caregivers with the facilitation of mental health interventions for unaccompanied migrant youth. For example, teaching informal caregivers to understand the behavior of the young person and providing informal caregivers with the tools to help the young person to improve their daily routines (for example, sleep hygiene). Therefore, resilience- promoting mental health interventions could be embedded into the everyday life of unaccompanied migrant youth.
Background: In our study, we investigated the potential role for technology in promoting resilience in unaccompanied migrant youth – a uniquely challenging and under-researched population. In order to design effective technology that provides appropriate support, we need to further understand how the current support structure functions, how resilience manifests, and what the current challenges are.
S-06-007
Indicators for strategies and challenges of youth mental health support interpreted as mental health technology design challenges
T. Michel*
*Technical University, of Vienna, Austria
Method: Semi-structured interviews with mental health practitioners in Austria and the United Kingdom were conducted with the goal of identifying shared strategies and challenges when promoting youth mental health. The interviews were evaluated using Thematic Analysis, and subsequently juxtaposed with relevant literature.
Results: We found indicators for consistent strategies and challenges relating to mental health promotion in young people across Austria and the UK, different mental health professions, different paradigms of care, for different ages, and for different types of young people, which could be linked back to relevant literature.
Conclusion: It may be possible to support a wide range of mental health promotion efforts by focusing on mental health technology to address these consistently applied strategies and challenges.
Background: Young people suffer the highest risk of mental health problems, while also being least likely to receive mental health support. Modern technologies may be used to more effectively deliver preventive youth mental health interventions, specifically to improve wellbeing and enable flourishing.
However, facilitating this is predicated on understanding current best-practice activities – both theoretical and embedded in practice - through the lens of human-computer interaction research.
and depressed patients P. Hafiz*
*Technical University of, Denmark (DTU), Copenhagen, Denmark
Method: We conducted a literature review to identify existing platforms and are in the process of developing mobile sensing platforms for the assessment of cognitive impairment on younger patients.
Results: We identified that working memory, verbal memory, psychomotor speed, executive function, and attention are key cognitive functions. We also identified that it is possible to measure them using the platform we are developing. To date, some applications have been deployed, but there are still gaps to be explored, such as the application of gold-standard neurocognitive tests and passive-sensing to identify potential mental health issues.
Conclusion: Digital technologies can add great value to the diagnosis and treatment of mental disorders, as they are easy to access by younger users and the extraction for cognitive and behaviour features is technically feasible.
Background: The collection of behavioural and cognitive data using mobile sensing allows the pervasive monitoring of patients and paves the way for the early detection of their mental disorder by psychologists and psychiatrists. This is especially relevant in the case of children and adolescents, who are enthusiastic users of mobile devices. Our goal is to investigate how tests and ubiquitous passively-sensed data could be used for the assessment of behavioural and cognitive features in young users.
S-06-009
Power up for parents: Developing a digital intervention to promote shared decision making in child and adolescent mental health services
S. Liverpool*, J. Edbrooke-Childs, M. Wolpert
*University College London, United Kingdom
Method: In collaboration with parents, clinicians and an app development company, we designed an innovative mobile application called Power Up for Parents to encourage and support parents to be more involved in their child’s care and treatment decisions. The development process involved reviewing the literature, patient and public involvement sessions with parents, interviews with clinicians, and followed the guidelines for developing and evaluating patient decision aids.
Results: This talk will present 1) findings from the literature reviews, 2) the development and design process, including key learnings and challenges, 3) key features of the app including a demonstration, and 4) evaluation and dissemination plans with preliminary findings.
Conclusion: The findings from using this approach to designing and developing an evidence-based mobile application, for use by parents, to promote shared decision- making in CAMHS can have implications for practitioners, policy-makers and researchers. Preliminary user feedback and the involvement of parents throughout the process can also provide some valuable insight.
Background: Parents and primary caregivers involvement in CAMHS is crucial given that parents often serve as gatekeepers to their children’s mental health care and treatment. Research highlights that caregivers’ involvement in services has been linked to improvements in child health outcomes.
However, mental health care and treatment decisions for children and young people (YP) can be challenging. Although shared decision- making is viewed as a best practice, more work needs to be done to facilitate this process.
the complexity of care and suffering (AEPEA Symposium) Chairpersons: B. Golse, France; P. Fourneret, France
B. Golse*
*Université Paris Descartes, Sorbonne Paris Cité, France
S-07-001
The lived experience of first episode psychosis among patients and their families:
A metasynthesis J. Sibeoni*
*Psychiatrie de l´adolescent, Argenteuil Hospital Center, ECSTRRA Team, UMR 1153, France
Method: This metasynthesis follows thematic synthesis procedures. Four databases were systematically searched for qualitative studies reporting first episode psychosis from the patient or family’s perspective. Article quality was assessed with the Critical Appraisal Skills Program. Thematic analysis was used to identify key themes and synthesize them.
Results: 39 articles were included, covering data from 505 participants (337 patients and 168 relatives). Four themes emerged from the analysis: (1) lived experience of psychotic symptoms:
a curious absence, (2) A confusing experience: between continuity and rupture, (3) a contrasted experience and (4) to give a meaning to this experience.
Conclusion: Our results found important discrepancies between patient’s and family’s experience, especially regarding positive aspects. In light of the confusing experience found in our results, we will also discuss the rightness of the term First episode psychosis.
Background: For the past twenty years, the prodromal and early stages of schizophrenia have been of increasing interest. Specific interventions and programs have been developed around the first episode psychosis (FEP). There is also an increasing literature on the latter, reporting both quantitative and qualitative studies. Qualitative studies appear to us particularly relevant in this
S-07-002
School refusal: Burn out of presenting oneself in everyday life L. Benoit*
*Maison de Solenn, APHP, CESP INSERM 1178, Université Paris Descartes, France
Method: More than 50 in-depth interviews with teenagers and their parents were recorded and transcripted. The qualitative analysis was carried by two researchers, using the Grounded Theory methodology.
Results: If school refusal appears as an immediate shift, it answers to a process of long duration.
For some students, struggling to attend school from day to day required a consuming work: the presentation of self in public, self-awareness and emotional work towards peers. Meanwhile these feelings failed to be embodied and their belonging to the school social network appeared artificial to these teenagers. After refusing school, the participants described their relief. They started a pathway in deconstructing and reconstructing their socialization and self, from “as-if” relationships to more authentic ones.
Conclusion: Medical diagnoses that had been made for these teenagers (depression, autism spectrum disorder, suicidal risk, high IQ) and several therapeutic options (CBT, group therapy) are discussed and enlighten by this sociology of identity.
Background: School refusal is an increasingly common motive for consultation in child psychiatry.
According to the psychiatrists, situations leading to school refusal are extremely diverse, from anxiety feelings in the classroom to severe psychiatric disorders, and may lead children to miss school occasionally or to give up their studies. This sociological study describes the career of teenagers who receive psychiatric care because they refuse to go to school.
A systematic review of the qualitative literature l. Braoude*, J. Sibeoni, T. Huppert, A. Revah-Levy
*Psychiatrie de l´adolescent, Argenteuil Hospital Center, ECSTRRA Team, UMR 1153, France
Objective: The immediate and long-term consequences of children’s exposure to complex trauma such as sexual abuse are well-known. Sexual abuse would impact the development of the child with a higher risk for additional trauma exposure and cumulative impairment, especially psychiatric and addictive disorders. To identify and to disclose such abuse is therefore a major challenge for healthcare providers in general, child & adolescents mental health professionals in particular.
Qualitative studies are relevant in this context, focusing as they do on the views of the stakeholders –children, relatives, professionals- of how they experienced such investigation and disclosure.The aim of the study we will present is to address the question of how child and adolescents mental health professionals investigate child sexual abuse by exploring the views of all stakeholders through a systematic review of the qualitative literature
Method: Four databases will be systematically searched for qualitative studies concerning sexual abuse and mental health.
Results: The analysis of the articles included in this review will directly address the lived experience, facilitators and obstacles concerning the professionals’ investigation of a child sexual abuse among patients.
Conclusion: The results of this review will give us a better understanding of what is at stakes around investigation and disclosure of child sexual abuse in the field of child and adolescent psychiatry.
S-07-004
Narratives of unaccompanied minors and improvement in their social care S. Minassian*
*Maison de Solenn, APHP, CESP INSERM 1178, Paris, France
Method: The presentation will focus on follow-up research conducted by the action-research group NAMIE (Nouvel Accueil Mineurs Isolés Étrangers), at the Cochin Hospital from 2012 to 2016. The presentation will focus on the UAMs’ perspective of time and on a narrative analysis of qualitative interviews conducted with them at the beginning and the end of the process. A transversal secondary study to underline the differences among the UAMs’ population will also be detailed: the various levels of psychological distress and different sociological profiles and experiences).
Results: Uaccompanied minors who reported high levels of psychological distress presented fragmented narratives (structure) and a temporal discontinuity with a dominance of temporal elements from an untold past. Those who reported low levels of psychological distress also had fragmented narratives at the beginning of the therapeutic process, but progressively reintegrated those fragments in a temporal continuity (the dominant elements of the past are recaptured and reconnected with the present and the future).
Conclusion: In the NAMIE clinical setting, we allow patients to talk about traditional cultural meanings and their experiences of rupture and identity construction in a context of war or conflict. The minor’s resources and coping strategies are considered. Finally, we assist them in their ability to produce an inclusive narrative of a culturally mixed adolescence. This transcultural approach appears to be a relevant framework to re-activate identity construction processes.
Background: In France, the number of unaccompanied minors (UAM) has significantly increased recently leading to challenges for child protection social services to provide them with adequate care (10% of children supported by these services are UAM). Child protection social workers document the difficulties they face in trying to meet targeted needs such as proper healthcare for somatic diseases or injuries and mental health and psychiatric care. Our objective was to better understand
in migrant adolescents treated for a depressive disorder J. Lachal*
*Maison de Solenn, APHP, CESP INSERM 1178, Université Paris Descartes, France
Method: We will present the protocol of a mixed study designed to assess the efficacy and acceptability of transcultural psychotherapy for the treatment of depression in first or second generation of migration children and adolescents.
Results: The quantitative component will be an open randomized control trial assessing the percentage of patients in remission at 28 weeks after the start of transcultural psychotherapy versus usual care. The qualitative component will lay on phenomenological analysis to explore the perceived efficacy and acceptability of transcultural care, as well as therapeutic processes that enabled the improvement of patients. Families, as well as therapists will be interviewed.
Conclusion: We will insist on how quantitative and qualitative components are combining to improve the quality and complexity of the results.
Background: The symptomatic and clinical expression of psychiatric disorders in children and adolescents is strongly influenced by the cultural setting they are growing up in. These cultural variations complicate psychiatric care, especially for the children with a migrant background, for whom appropriate care must be designed. Transcultural psychotherapy is an original psychotherapeutic technique developed to meet these specific requirements in France and in different European and American countries. Transcultural psychotherapy proved its clinical relevance many times but neither its efficacy nor its acceptability have been studied until now.
S-08
WAIMH Invited Symposium:
Premature babies at the NICU: The interface between pediatrics and infant psychiatry Chairpersons: M. Keren, Israel; K. Puura, Finland
M. Keren*
*World Association for Infant Mental Health, Tampere, Israel
S-08-001
Co-creation of family centered care for neonatal intensive care unit of Tampere University Hospital
K. Puura*
*Tampere University Hospital, Finland
Objective: In neonatal intensive care units (NICU) parents are encouraged to spend as much time as they can with their infant. For the staff this means being in interaction with the parents throughout most of the work shift, which can be stressful at times. The aim of this project was to co-create a model for family centered care that would help both families and staff.
Method: Child psychiatrist specialized in infant mental health had two discussions with the head nurse and a nurse from the NICU. In the discussions a half day workshop was developed to help the staff with three questions: 1) how parents of premature babies react and behave in their distress, 2) how to cope with parental distress in a helpful way, and 3) how to recognize families who will need intensive support after the NICU treatment. Each of the questions was addressed in a socratean seminar. The workshop was repeated six times to include the multiprofessional staff of neonatologists, psychologist, social worker and nurses.
Results: The participants identified different types of parental distress reactions ranging from withdrawal to hostility. Becoming aware of the distress reactions helped them come up with ways of dealing with the parents. Working together as a group and sharing their joint knowledge empowered
M. Keren*
*World Association for Infant Mental Health, Tampere, Israel
Method: The link between 47 mothers’ narrative regarding stay at the NICU and the quality of their interaction with their very low birth weight (<1650 gr) premature singletons was assessed prior to discharge. Maternal representations were assessed with the CLinical Interview for high-risk Parents of premature babies (CLIP), a semi- structured interview that explores mothers’ experiences of the pregnancy, delivery, hospitalization period, thoughts and feelings about the infant. Ten minutes of mother-infant interaction was videotaped, and global and micro-analytic codes were used to define three interactive variables: maternal adaptation, maternal touch, and infant withdrawal.
Results: Mothers with positive representations had more optimal interactions with their premee than mothers with negative representations. Maternal adaptation to the infant’s signal and maternal positive touch were each uniquely predicted by the mother’s readiness for the maternal role, and were each negatively related to maternal depression. The infant’s interactive withdrawal was independently predicted by maternal rejection
Conclusion: The present results point to the relations between the indicators of the mother’s working through of the experience of premature birth, the mother’s psychological factors and the mother-child interactive patterns when the infant reaches term age and approaches discharge. The CLIP interview may be a useful wrapping-up tool of traumatic experiences related to prematurity, to detect those mothers in need of further intervention towars discharge.
Background: Maternal engagement with her premature baby prior to discharge from the NICU predicts the mother’s engagement with her child at three months. Although most parents overcome the state of shock, bewilderment, panic, and sadness that are characteristic of the first weeks at the NICU, and go through the bonding process, some don’t and need to be detected before discharge.
